Kaisu

I don't hate you. I don't note JVD in the field and don't use it for clinical signs. It points towards cardiac tamponade ( or any filling of the right ventricle). Do you have a decreasing pulse pressure? I think you mentioned muffled heart sounds earlier. Don't tell me you did a pericardiocentesis? I would be sooooo jealous.

I am not even going to worry about pain/anxiety at this point vis a vis medications. I think we are dealing with a major bleed at this point - I would guess a dissecting aorta. Get that rotor on it's way and get that patient to definitive care. The MAP is not ideal and it is symptomatic with confusion. Hi-Flow O2, hoping that will clear the confusion without jacking up the BP and aggravating the bleed.

How would you support that BP? OP What is the MAP?

My first guess is cardiogenic shock. Any cardiac history?

It would be nice if more of the public was aware of our role, but only in the context of increasing their awareness of what is appropriate and what is not appropriate in emergency situations. The public thanks or glory means less than nothing. It embarrasses and confuses me. More important to me is the look of relief in the eyes of patients and their loved ones when I show up and do my job. The scared patient that relaxes in my rig, cries tears of relief and grabs my hand means more to me than any freaking stupid EMS day. The respect of knowledgeable peers is more meaningful than any publicity mill bullshit. I am quite OK being the bastard stepchild. It allows me to do my job out of the glare of the spotlight and protects my already ego driven soul from a slippery slope.

Excellent post eb. Uncommon but not rare and grossly underdiagnosed. Consider my brain tickled

True. Have never run on a CF patient, so forgot about them.

Asthma is an autoimmune disorder - a reactive airway disease. Its present from birth - although symptoms take awhile - and symptoms often disappear due to increase in the size of the airway. COPD - emphysema and chronic bronchitis are acquired through a pathophysiological process - destruction of alveoli in the one, increased production of mucus secreting cells in the second and accompanying airway inflammation in response to irritation. Asthma you are born with - COPD you get - usually after asking for it for decades.

Rock shoes, thank you for educating me. You are absolutely correct. That A1C does correspond to an average BGL of 143, which is diabetes. Teach me to shoot my mouth off. In my defense, I live with a diabetic and we target an A1C of around 6%, reassuring ourselves that the diabetes is under control. DFIB, sorry to steer you wrong. Listen to the smarter people here and get thee to an endocrinologist,

A blood glucose of 105 and an A1C of 6.2 is not diabetes. This indicates blood sugar levels within normal limits. Remember that the A1C reflects average blood sugar levels over 3 months, the life span of a red blood cell.

I gave you a negative for that. Why would you take the albeit slight risk of injecting a substance into a patient with no therapeutic benefit for the patient?

The thing to remember is that no-one raises their hand and says "yes please - I'll have the schizophrenia and while you're at it throw in some addiction issues too." These people, through no fault of their own, are ill and need help. They call us because we are what there is when people need help with health problems, including mental health problems. If you are fortunate to live in a part of the country with good mental health services, than at the very least, you serve as an entry point into the system. At the other end of the scale is saving a life - someone for whom the pressures to commit suicide outweighed the resources to overcome the pressures. Nobody that aspires to be a health care professional gets off with the excuse "they didn't teach us that in school." If you are running on these patients, than you have an obligation to educate yourself so that you can be of help to them. It's your job.

I celebrated my 50th birthday in my final semester at medic school by catching a baby. (it was a girl). It is a difficult job, especially if you focus on the BS. If you are in it for the right reasons it can be extraordinarily fulfilling. It's a good alternative to the Walmart greeter position, but with a lot less sleep.

Once again, I have learned something - or perhaps relearned.. Thank you kind posters

I was Initially sceptical, primarily because I have an antipathy for CISM, especially as practiced in the areas I have run. I looked at the video to find a way to eviscerate you. The video is difficult, as it brings out into the open a subject I have always dealt with by numbing, nay even becoming a purveyor and enjoyer of trauma porn. The video is beautifully done, intelligent and edifying. It gives us a structure and names things. I found the victim triangle very helpful. Kudos to you sir.

maybe some serious manscaping?

You are going to have soooooo much fun. I almost envy you. Maybe once word gets around, EMS will get a break too....

I've had the survival to discharge a couple of times that I know of. A lady that coded in the back of my rig, then coded 3 times in the cath lab. I went up a few days later to see her. She was sitting up and thanking me for being her "saver". The one I will never forget is the 3 1/2 week old discharged 2 days later with no deficits. You just never know.

I have never had a senior partner. My 1st EMS job ran 1 EMT and 1 Medic. I got 20 ride alongs with a senior medic that was supposed to show me the ropes. I had 8 or 9 different people; 2 or 3 of them tried to help me, but the system did not facilitate a mentor/mentee type of relationship. I was thrown to the wolves to sink or swim. That has subsequently changed in this system, with a formal FTO setup. It is much better for the newbies coming in now. I should mention that an experienced EMT volunteered to be my permanent partner. She did everything in her power to help me and I will always appreciate it.

It's always tough when it is a friend or family. There is an emotional residue that takes a while to work out. Good for you for posting. It's part of the process.. (As I'm sure you already know) Good work and our prayers are with your friend.

I have to disagree. 38 year old man with chest pain and a cardiac history SHOULD have had cardiac markers/enzymes run.

maybe they gave you the wrong test

Quoted from the article: " Duck would complain about his work and never, ever admit that he could be wrong" "assigned to check call boxes in the borough but Duck was reluctant to do it. Startzel said he nagged at Duck until he got up, jumped in the truck and checked all the boxes himself, not saying a word to Startzel when he returned" Yep - sounds like a stellar professional alright

Limb before life. If you can do it, and the helicoptor docs obviously could.. then I think it's a legitimate action.

One of my co-workers (not working with him now, but he's still working) did a field amputation of a leg. Patient was trapped under a train, seriously injured, similar to the patient in the scenario. It would have taken 20 minutes to move the train. The medic took the leg off and transported the patient. He didn't have to saw bone - there was soft tissue holding the leg on. The patient died in the ED.